Scotland among worst for stillbirths

Published on Saturday 30 May 2009 19:48

SCOTLAND has one of the worst stillbirth rates in Europe and the number of full-term babies dying before birth is rising, a new report has revealed.

A review of cases over the last 30 years has revealed concerns over the number of stillbirths in Scotland and calls for further investigation into the causes.

The report, by government experts, reveals Scotland ranks fourth out of 26 European countries for stillbirths among single babies – with rates worse than poorer countries including Estonia, Malta and Poland.

Last night critics warned many deaths could be avoided and blamed a "shocking" lack of staff at maternity units.

Around 60,000 babies are born each year in Scotland but around 300 die in the womb or during delivery. In many cases the reason is unknown.

The report, Perinatal Mortality In Scotland, by NHS Quality Improvement, is the most comprehensive study of its kind. It found that Scotland's stillbirth rate among single babies of 6.3 per 1,000 births is around twice as high as countries such as Finland, Luxembourg and Germany and much higher than the Slovak Republic, the country with the lowest rate, at 2.3.

Although stillbirths have halved since the mid-1970s, the report warns failure to achieve further reductions in the past decade "must be of concern and requires further investigation".

For babies who were not premature and died despite a pregnancy of normal length, the report warns of a "slight but steady rise" in stillbirths from 1.9 per 1,000 births in 1997 to 2.1 per 1,000 births in 2007.

There has also been an increase in the number of babies dying during labour, from 0.4 per 1,000 births in 2001 to 0.5 per 1,000 in 2007.

Although there are questions over whether this particular rise is due to the way data is recorded, the report warns the trend is "of concern" and calls for further investigation.

The report's author, Leslie Marr, reproductive health programme co-ordinator for NHS Quality Improvement Scotland, last night called for more research into the causes of stillbirths. She said: "Any stillbirth is a complete tragedy and we need to look in more detail to find out the contributing factors."

Last night experts blamed a number of factors including rising obesity levels and deprivation, but critics said women are not being looked after properly in labour.

Dorothy Maitland, of the Stillbirth and Neonatal Death Society (Sands) Lothians, blamed a lack of staff at maternity units: "I do think there is an issue about lack of staff, with women in labour being sent home from hospital. The lack of staff is shocking."

However, Dr Philip Owen, a consultant obstetrician at the Princess Royal Maternity Hospital in Glasgow and a spokesman for the Royal College of Obstetricians and Gynaecologists, said rising levels of obesity may be contributing to the problem.

He added: "Stillbirths should be a rarity but 300 in Scotland each year suggests otherwise. There would appear to be an inherent stillbirth rate that we are just not able to get below, which is very disappointing. It's the one thing above all that we don't want to happen, that's our main reason for being here and we are pretty obsessed with it. If other countries are genuinely managing rates as low as 3 or 4 per 1,000 births there's no reason why we can't aspire to that.

"The absolute risk to any woman is very low. But if women want to reduce their risks of stillbirth then before they become pregnant they should quit smoking, have health problems such as high blood pressure and diabetes stabilised, and if they are obese, look at getting to a normal weight. The relationship between stillbirth and maternal obesity is well recognised."

He added: "It's impossible from this report to say whether the standard of obstetric care is a factor but from the perspective of a working obstetrician, I would like to think that the standard of care that we provide is the highest."

A Scottish Government spokesman said: "Thankfully, stillbirths and infant deaths are very rare in Scotland and our maternity care is of a very high standard.

"The link between ill health and deprivation is well known and unacceptable. By tackling health inequalities now – for example, with record investment in smoking cessation, including funding to help pregnant women stop smoking – we hope to make further reductions in perinatal mortality and infant ill health in future."

Infertile couples to have say

INFERTILE couples are to be given a say on the way they are treated in Scotland in a bid to end long waiting times in some parts of the country.

The Scottish Government is funding a new initiative aimed at giving patients a role in determining fairer and faster access to NHS treatment.

Infertility services in Scotland are subject to a huge post-code lottery, with waiting times ranging from just three months in the Borders to up to three years in Lothian.

Many couples who are desperate for children end up paying privately for treatment instead at around 3,000 for each attempt, and it can often take several attempts before a couple are successful in becoming pregnant.

Under the scheme, Infertility Network Scotland, an organisation of past and present patients will be funded by the Scottish Government with 60,000 over three years to work with health boards on ensuring fairer access to treatment.

Talks will now begin between the government, health boards that refer patients and specialist NHS fertility centres on how to tackle waiting times and local differences in access to treatment.